Our guest-blogger is ARM member and Independent Midwife Sabine von Toerne. We’re very grateful to Sabine for her perspective on the current situation regarding independent midwifery in the UK. Please feel free to comment if you have any more information to add.

“Independent midwives… a little army of unique and emotionally intelligent women who are experts in normal birth.”  (Milli Hill)

Yes, it is true. Independent Midwives, often just called IMs, are back in action! It all happened rather quietly since October 2017 and apart from a few posts and discussions on social media, it hasn’t been talked about much. New options for indemnity cover for self-employed Independent Midwives in the UK as well as the Republic of Ireland have become available www.mymidwifeandme.co.uk; and more and more Independent Midwives have picked up their pinards and sonicaids again, providing the full scope of midwifery care, including birth attendance.

I am an Independent Midwife myself, and in my daily work, I still meet birth workers and families who are completely unaware of this development. They are NHS midwifery colleagues, obstetricians, doulas, researchers, lecturers, writers, campaigners and of course, pregnant women looking for a midwife.

Last week the amazing Toni Harman (‘Freedom for Birth’, ‘Microbirth’) messaged me on LinkedIn and Toni hadn’t heard the news yet. So I thought, right, if Toni – who is in touch with so many birth folks – still doesn’t know, who else still doesn’t know? Let’s change that! And I could not think of a better reason to write my first ever blog post.

There are many different reasons why families might engage the services of an independent midwife: Some couples simply want to go on the journey of pregnancy, birth and first weeks with their newborn, with a midwife they can build a trusting relationship with, a midwife who understands their individual family situation, their motives, their choices, their wishes, their needs. Hiring an Independent Midwife is often the only way to guarantee true continuity of carer. Other families have opted for a home birth, but have been told there is uncertainty that NHS services will be able to meet the demand on the big day. Then there are mothers who choose a homebirth after caesarean (HBAC) and who look for midwives with expertise in vaginal births after caesarean at home, or for a midwife who is experienced in twin births or breech. Many families have researched their birth options well and understand that having a familar midwife at their birth minimises the likelihood of unnecessary interventions and greatly increases their chances of a natural birth (Sandel et al. 2016). And then there are women with previous traumatic births, usually in a highly fragmented care system, or women with a history of abuse who do not want to have to ‘tell their story’ over and over again.

Most of the readers will be aware that UK-based Independent Midwives have been through turbulent times as they had no indemnity for birth care to rely on when the clock struck midnight on 10th of January 2017. This problem concerned self-employed Independent Midwives…

What? It’s all a bit confusing – Private Midwives, Independent Providers and Independent Midwives? What is what?

Apart from private maternity hospitals like the ‘The Portland’, the ‘Westminster Suite’ at St Thomas’ Hospital, The ‘Kensington Wing’ at Chelsea and Westminster Hospital or the famous ‘Lindo Wing’ at St Mary’s Hospital, all of which are obstetrician-led, there are several types of independent midwifery care providers who provide community-based midwife care and home births services ‘independently’ of the NHS, some ‘privately’ and paid for, and some free.

The largest provider are ‘One to One Midwives’, a commissioned service, free for women to use, providing homebirths and continuity of midwifery care across Cheshire, Merseyside and Northeast Essex. There are also ‘Private Midwives’  who provide private midwifery care throughout many areas of the UK and Ireland, a paid for service; and the Neighbourhood Midwives who provide private independent midwifery care throughout London, Hampshire, Dorset and parts of Kent. Neighbourhood Midwives also run a NHS commissioned service, free at the point of use for women, in Waltham Forest, Northeast London.

‘One to One Midwives’, ‘Private Midwives’ and the ‘Neighbourhood Midwives’ have all been operating normally and were not affected by the indemnity crisis impacting on Independent Midwives’ ability to attend births in the UK in 2017. It was self-employed Independent Midwives who were affected and unable to attend births, unless they had contracts with one of the above providers or the NHS in place, which was achieved by quite a substantial number of IMs. The situation has now changed, and self-employed Independent Midwives are able to acquire indemnity cover and attend births again. Phew… ! I hope this explanation worked?

A little bit of history: it was clear from 2010 onward that the insurance market had little interest in IMs as their numbers were relatively small and a claim, although unlikely, was potentially very high (Department of Health 2010).  Against the odds, self-employed Independent Midwives succeeded in securing professional indemnity cover just before it became a legal requirement for all health care professionals working in the UK as a result of an EU Directive, in July 2014. Professional indemnity has the purpose of providing a form of redress for families in very rare cases with a tragic outcome, where negligence by the practitioner has occurred. The UK data we have in regards to maternity care litigation stems nearly exclusively from NHS care episodes and does not distinguish between obstetrician-led and midwifery-led care. Many of the litigation cases are a result of system failures, communications errors, over-intervention and iatrogenic harm. Independent Midwives, in general, have exceptionally good outcomes and women and babies receiving their care have their physical and emotional well-being attended. Women tell us that it is both a healthy baby and their experience of the birth that count, not either or. Women’s emotional well-being matters greatly – being listened to, being taken seriously, being given all the information, being offered choices (National Maternity Review 2016).

The commercial insurance product for UK-based self-employed independent midwives was in place since July 2014. A year later, in July 2015, it was replaced by their memberships organisation’s own indemnity scheme. This scheme was later found to be ‘inappropriate’ by the Regulator and as of 11th of January 2017 self-employed midwives who were members of Independent Midwives UK (IMUK) were not able to rely on it anymore.

In the immediate aftermath of the decision, petitions were initiated and rapidly gathered over thirty thousand signatures, demonstrating the need, demand for and support for independent midwifery. Simultaneously, innovative practical solutions were found. Two large NHS Trusts, Airedale in Yorkshire and Chelsea and Westminster NHS Trust in London, initiated successful co-operations with Independent Midwives, so women could continue to be cared for by their chosen midwife. Similar co-operations are running in Wessex at Portsmouth, Southampton, Salisbury, Bournemouth, Poole, and Dorchester NHS Trusts. Pregnant and labouring women will be looked after by the same Independent Midwife throughout; they contact Independent Midwives for antenatal and postnatal care and on call commitment for the birth and the midwife is indemnified for birth care via the NHS;  these projects are ongoing.

While Independent Midwives were still attempting to legally overturn the Regulator’s decision, which came to closure on the 12th of December 2017 with a High Court verdict deciding in the NMC’s favour, very quietly and without much ado, new avenues had opened up and the ‘My Midwife & Me’ scheme was born, enabling IMs to access indemnity cover. Initiated by Jo Parkington from ‘One to One Midwives’,  the scheme became accessible on 1st of November 2017 and an increasing number of midwives in the UK as well as the Republic or Ireland are signing up to it. A second scheme became available shortly after wards, provided via Private Midwives.

This means that Independent Midwives are back in action! They can provide the full scope of midwifery care without any restrictions on women’s choices, providing gold standard of care, with huge short and long term health benefits for women and their babies. The Better Births Report (2016) states: “Every woman, every pregnancy, every baby and every family is different. Therefore, quality services must be personalised”. Independent Midwifery represents exactly this high quality standard based on the continuity of carer model, thereby driving positive change in the profession and maintaining midwifery skills in the UK and internationally.   It is therefore fabulous news that Independent Midwives can practise again. Please share this post widely and spread the good news!

PS: There is currently no comprehensive search facility or database available to find all Independent Midwives though a directory is being prepared. In the meantime, women looking for Independent Midwives can find their local IMs via a simple Google search.    

www.imuk.org.uk

www.mymidwifeandme.co.uk

www.neighbourhoodmidwives.org.uk

www.neighbourhoodmidwives.org.uk/nhs-care

www.onetoonemidwives.org

www.privatemidwives.com

Department of Health (2010) Professional insurance and indemnity for regulated Healthcare Professionals – policy review research. [online] Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/216298/dh_117480.pdf

National Maternity Review. (2016). BETTER BIRTHS, Improving outcomes of maternity services in England. [online] Available at: https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf

Sandall J, Soltani H, Gates S, Shennan A, Devane D, Midwife-led continuity models versus other models of care for childbearing women, Cochrane Database of Systematic Reviews 2016, Issue 4. DOI: 10.1002/14651858.CD004667.pub5

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